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RD does NOT stand for “Really Dumb”

All you need to do is google “dietitians are stupid.” (Go ahead, I’ll wait here.) “Dumbshit nutritionists” [Free the Animal] all over America are apparently giving out “misleading, scientifically vapid, and possibly harmful information” [Postpartum Punk]. Sadly, it is sometimes hard to argue with that.

The Academy of Nutrition and Dietetics has a professional “Code of Ethics” that states that all Registered Dietitians should avoid even the appearance of a conflict of interest.

“The dietetics practitioner does not invite, accept, or offer gifts, monetary incentives, or other considerations that affect or reasonably give an appearance of affecting his/her professional judgment.” *

Despite these snugly-fitted, professional handcuffs, there are plenty of RDs out there who not only think for themselves, but who are working to change the system—each in her own way. What they have in common is an unwavering belief in the importance of food in creating healthier individuals and communities. Truly, these women are amazing:

Valerie Berkowitz MS RD CDN CDE worked with Dr. Robert Atkins for a number of years, but has gone one to create her own approach to healthy eating. Valerie is the author of The Stubborn Fat Fix: The Essential Guide to High Fiber, Low Carbohydrate, Whole Food Diets. The book is the basis for a learning module for continuing education credits for RDs—yup, you read that right. Thanks to Valerie’s commitment to making carbohydrate-reduction a mainstream option for health professionals, RDs can get continuing education credits for learning more about low-carb diets. More evidence of her commitment? I got to know Valerie well when I worked with her on a review paper on low-carbohydrate diets —while she had a newborn in tow. (All I did when my children were infants was pray for the opportunity to take a shower.) Valerie works with her husband, Dr. Keith Berkowitz, as the Director of Nutrition at the Center for Balanced Health, while blogging, writing, and mothering four active children. I know, I know—it makes me want to take a nap just reading about her. But I promise she is fully human and a lovely person. Go visit her at Valerie’s Voice: For the Health of It.

Cassandra Forsythe PhD RD has worked with low-carb researcher Dr. Jeff Volek, but that doesn’t even begin to describe the breadth of her expertise. She combines a background in dietetics, nutrition, and exercise science with a particular interest in women’s health—especially mommy health. If you happen to be a reader with more of a passion for working out than I have (which is likely to be every reader) or if you are not interested in joining the “fat mother’s club” (as my brother so charmingly described the tendency of bearing children to leave women looking permanently 5 months pregnant), check out her fun/exhausting combination of “cute baby and badass mommy” blog.

Suzanne Hobbs PhD RD comes from a different nutrition perspective than many of the women on my list, but she is—quite literally—the only person in America whose area of expertise encompasses both nutrition care and nutrition policy and politics. She is a lifelong vegetarian who writes a newspaper column highlighting the nutrition benefits of a plant-based diet. But she is no more of a vegetarian hard-liner than I am a low-carb one. Instead, she understands that the food choices that people make are complicated, the environment in which those choices are made is confusing, and the real target of concern—for any nutritional paradigm—should be how to take this big messy picture and frame it in a way that will allow us to improve public health nutrition for everyone, rather than to promote any one nutrition agenda. She helped put vegetarian nutrition on the map in the world of dietitians as well as the world of policy. I’m hoping I can learn from her how to stretch the old “top-down” model of nutrition guidance into a new shape that allows us to start thinking differently about how to accommodate individualized nutrition to a public health framework.

Karen Holtmeier MPH RD LN is the RD counterpart to Mary Vernon’s MD leadership at the American Society for Bariatric Physicians as well as director of her own weight loss clinic. She has been educating dietitians and nurses that work with bariatric physicians about the positive health effects of carbohydrate reduction for over a decade, while remaining active within the RD professional community. Not an easy feat to pull off, but Karen is not only warm, funny, and politically savvy, she’s one of the most intrepid women I know. (Traveling by myself still is a little nerve-wracking–with a husband and three kids, I’m used to traveling in a mangy but secure pack loaded down with coolers, pillows, and a bookmobile’s worth of reading material; Karen thinks nothing of hopping in the car for an extended road trip, by herself, up the US west coast and into Canada—tralala. I love that.)

Kris Johnson RD (retired) is one of those “mystery women” I’d run into all over the internets. Like Carmen Sandiego, everywhere I’d go, she seems to have gotten there first. Outraged and intelligent commentary on the attempts of the Academy of Nutrition and Dietetics to create a monopoly on nutrition guidance?

As a retired and reformed dietitian, I can say flat out, dietitians do not understand all there is to know about nutrition. In fact conventional RD’s persist in promulgating some very bad science, such as the misguided advice to avoid saturated fat and cholesterol and aim for a low fat diet. Much of the really useful nutrition information I learned after I retired.

A science-based view of saturated fat in response to outdated precautionary warnings?

Those who have looked carefully at the research have found no evidence that natural saturated fats or cholesterol actually cause heart disease or any other health problem. . . . Excessive amounts of polyunsaturated fats and the trans fats derived from them are the real problem. The best way to improve important cardiac risk factors, that is increase HDL and lower triglycerides, is to limit carbs and most vegetable oils, while getting adequate natural saturated fats in the diet.

I think one of the coolest things about Kris is that she worked as an RD for 15 years, retired, and—instead of spending all day playing Suduko—then she went on to read and learn enough about the shifting paradigm in nutrition to become a vocal and articulate advocate for change. Amazing. Check her out at www.MercyViewMedow.org.

Stacia Nordin RD combines her nutrition expertise with permaculture knowledge and the desire to end hunger in Malawi, Africa in a socially, environmentally, and nutritionally sustainable way. Never Ending Food is a family endeavor she shares with her husband and her daughter (who was born in Malawi). I met her after getting a post about the AND’s campaign to create a monopoly on nutrition guidance yanked from an RD discussion board. Her response was sympathetic and encouraging, and she introduced me to a number of other RDs whose agreed with my position, but who had much better diplomacy skills than I do! (One day, we would like to create a network of nutrition professionals with an array of credentials—RD, CNS, CCN, CNC, health coach—to work together to create an environment where all of us can practice our profession with mutual respect.) In the meantime, Stacia and her family’s work continues to inspire me to think about how to make sure that our food reform efforts begin with the communities that they are intended to serve.

Annette Hunsberger Presley RD, co-author of The Liberation Diet, was censured by the (then) American Dietetic Association for recommending that her clients use butter instead of margarine. When told to review the ADA’s Evidence Analysis Library (whose idea of “evidence” is so limited and biased that I have a hard time typing the phrase with straight face) to get the “facts” straight and renounce this position, she did. Plus, she reviewed the rest of the science on the subject and reached a conclusion—as you may have guessed—with which the ADA was not at all happy. You can read her Hyperlipidemia Report here; it’s a pretty amazing piece of work.

Pam Schoenfeld RD is not only a wife, mother, clinician, and public health advocate, she is also the person I blame for getting me into this mess! Together we started Healthy Nation Coalition, and it’s been quite an adventure.I still have the email she sent Dr. Eric Westman (the MD I worked with at the Duke Lifestyle Clinic), and which he passed on to me, describing some of her experiences as an RD intern. Her passion, concern, and professional assessment of nutrition science were inspiring and contagious. She convinced me that I wasn’t too old to go back to school and that I’d come through the dietetic groupthink hazing intact. She was—more or less—right. She remains my hero, mentor, and dear friend.

Here’s our “dumbshit nutritionist” speaking to the Registered Dietitians assembled at the North Carolina Dietetics Association conference in April 2012. Fangirl that I am, I literally tried to write down everything she said:

“The 1977 Dietary Goals were based on politics, not science.”

“Humans can adapt to a wide variety of diets—from 80% carbs to 80% fat.”

“Increasing intake of plant foods, which are low sources of protein, is a bad idea for growing children.”

“People who eat more carbohydrates weigh less, so eat more carbohydrates. Um, it doesn’t work like that.”

“A lot of people don’t get enough protein because of what they are choosing.”

“Dietary advice often has unintended consequences.”

“Micromanaging the diet by imposing strict dietary rules is difficult to support with evidence-based nutrition science.”

“Pink slime was created to come up with a low-fat, high-protein thing to put into processed food.”

“I believe fat needs to go higher and carbs need to go down.”

“It is overall carbohydrate, not just sugar. Just to take sugar out is not going to have any impact on public health.”

Dr. Slavin is NOT a low-carb or paleo diet advocate; she is simply reporting on the realities of nutrition science and policy. But if you have any lingering concerns about her being a “lackey” for the USDA and food industry, here she neatly and sweetly skewers the whole paradigm:

The 2010 Dietary Guidelines for Americans supports less consumption of sodium, solid fats, and added sugars. Make half your grains whole and half your plate fruits and vegetables. Seems simple for the food industry—keep slashing salt (but make sure my food is safe), get rid of added sugar (but add fruit and fruit extracts to everything), and make chips, pizza crust, cookies, and all other grains “whole” so they are healthy. Probably a good idea to tax soda, outlaw French fries, ban chocolate milk in schools (added sugar is bad, right?), and over-regulate school lunch, restaurants, and food manufacturers. Let’s blame the victim too—we know fat people are lazy, uneducated, and low income—too bad they live in food deserts and don’t have access to fresh fruits and vegetables. Hope my BMI is under 25 today!

Dr. Slavin is a mainstream nutrition expert and RD. She is also an independent thinker and a true scientist. The paleo community’s stance in making nutritionists like Dr. Slavin out to be the “enemy” is not only short-sighted and counterproductive, it’s inaccurate. People like her will pave the way for better public health nutrition for everyone–including those who choose paleo diets.

This list would not be complete without a shout-out to all the dietitians I’ve met at the newly-formed PaleoRD group started by Aglaee Jacob MS RD—who deserves her own hooray (Aglaee, Your Paleo RD! It rhymes and everything!). I hope that the existence of such a group—you don’t have to be “paleo” to join—will encourage other RDs to stand up for their own professional understanding of the science and not feel afraid of being censured. There is strength in joining our voices together.

I’d love to hear about other RDs who share the belief—to paraphrase Kris Johnson—that the Academy of Nutrition and Dietetics doesn’t know all there is to know about nutrition and the conviction that as dietitians and nutritionists, we can and should exercise our professional expertise and judgment to help heal the world through food.

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26 thoughts on “RD does NOT stand for “Really Dumb””

I love this post and it gives hope to all of us who have “fought against the machine” so to speak. I also want to share with you, not to self promote, but because we have been told by numerous (not really dumb) RD”s that the world needs to know about this. As RD’s who understand nutrition, I am sure you have on more than one occasion been mortified by the ingredients of the enteral formulas that have been the only option of “nutrition” for the sickest of the sick in this country. I would like to introduce you to Liquid Hope, the world’s first organic, real whole food, no sugar added. non GMO, vegan and gluten free formula. (www.functionalformularies.com) Please spread this message far and wide if you’re so inclined. And I am going to say something that I do not say to RD’s very often…thank you for the work you do.

Robin, thanks for letting my readers know about this. Yes, many RDs are appalled at the stuff that goes into meal replacements for acutely ill patients–most of them don’t look much better than a liquefied Oreo, which btw are also vegan. Love the whole food approach–but why not a high-biologically available protein–i.e. animal source protein–version? Not everyone wants/needs a vegan formula & typically, what acutely-ill patients need more than anything else is protein, in the most easily-digested and absorbed form possible. For some folks, that’s going to be animal, rather than plant protein. When we are talking about the sickest of the sick in our country, I certainly hope that ideology takes a backseat to physiology.

Regarding animal vs. plant protein, creating a whole foods formula is full of challenges including the real food vs. chemical sugar water. As you know, the commercial formulas can hang for years at room temperature. Not so for real food which only has 3 hour hang time for plant based, much shorter for meat/dairy so that is one reason for plant based. Secondly, it is much more difficult to produce a meat based formula due to USDA regulations and cost, etc. so for our initial product for these two reasons alone we choose plant based. We also have research with people like Dr. Neal Barnard in regards to how meat and dairy affects cancer outcomes and on and on. I do not wish to get into any one philosophy about what foods may have best disease outcomes so I will let it suffice to say that there were many deciding factors why the plant based formula. By the way, according to our research many of the commercial formulas contain whey isolates making many of them not vegan. We will in the future be launching more formulas, looking at what ingredients may best support various conditions and agree that there is definitely not a one size fits all approach to nutrition.

I’m glad to hear you don’t have a one-size-fits-all approach! Nutrition absolutism–on all sides–is the biggest hurdle I face in trying to bring some sense to our current approach to food and nutrition. I’m sure there are logistical challenges to bringing a whole foods approach to meal replacements–no doubt convenience and shelf stability are a large part of the reason we end up giving liquefied Oreos to acutely-ill patients. I applaud your efforts to find a better way.

As you move forward, be sure to look beyond Dr. Barnard’s work; all science emerges from a human context & his certainly emerges from a strong personal preference for a vegan approach. Don Layman, Robert Wolfe, Elena Volpi, and Douglas Paddon-Jones have done a lot of work with protein synthesis in bed-bound patients. They tend to use hydrolized proteins for research purposes, so this would offer you an opportunity to try to use their findings in a whole foods format.

While I am certainly not opposed to a vegan diet for adults who choose it, we do have to remember that it is food belief system–one of many–and has little to do with biology, physiology, or biochemistry. Your insides don’t care where their essential amino acids come from as long as they are provided in sufficient quantities. If we can do this without also providing chemicals & sugars & other nonsense that the body doesn’t need, so much the better. I look forward to hearing more from your work.

that video was funny, rd doenst stand for really dumb. maybe it should be rd stands for really drunk. lol.I was wondering about the lowering affect of oatmeal, I am wondering if the lowered cholesterol is more about how the sugar is doing more damage to the cells and the cholesterol which is a glue to help cells deal with toxins and such is actually getting incorprated into the cell membranes due to increase carb intake? is that good or bad? so maybe they need to find other ways of determining good health besides blood tests, they only tell you parameters they dont’ tell you why.

Unfortunately, the way the Academy of Nutrition and Dietetics is set up right now, the “information and facts” we are taught–within the RD curriculum (I exempt my own program from this largely due to the efforts of Amanda Holliday, above), in our professional journal, at conferences, and at continuing education workshops–are all massaged by dogma and profit, PLUS we are not encouraged, or in some cases allowed (see Annette Presley, above) to question the gaps in logic and biological reality that we see.

That’s why I thought it was really important to hold these women up as examples of how real nutrition care is practiced–with a foundation of science and the art of compassion.

Loved the video – I finally got around to watching it. My only experience with an RD was about 12-14 years ago, when I went to my doctor asking “Why can’t I lose weight? I’m doing everything right!” (at the time, “everything right” was a low-fat high-carb calorie-restricted diet with chronic cardio.) I remember showing the RD my food diary, and she said “Yep, you should lose a couple pounds a week on that.” And my telling her, “No, I’ve BEEN doing this for six months and have gained ten pounds.” She just kept repeating that I “should” lose weight on that diet. The best she could offer was to argue about how many calories were really in my breakfast bagel.

I’m not faulting her personally for anything, she was simply dispensing the current diet philosophy of the time, as it had been taught to her. The part that struck me then, and still does, was that she couldn’t seem to process the idea that it wasn’t working. That’s when I began to get a glimmer of how futile it was to look for help from the medical community.

But I’ve also had a glimmer of the futility of looking for help from non-conventional wisdom (which will end up being the new CW in a few years, when someone comes up with another philosophy…) I”m not the only woman who’s said “I’ve been eating perfectly primal, how come I haven’t dropped 30 pounds in 2 months like everyone else?” There still seems to be a GIANT piece of the puzzle missing. So it is indeed very hopeful to see that there are some people looking outside current paradigms, and it’s encouraging that there ARE different opinions and focuses – that can only increase the chances of learning something useful.

I can’t tell you how many patients I talked to had similar experiences with RDs–to the point where I stop introducing myself as an RD and used the term “nutritionist.” Telling people to keep doing the same thing they’ve been doing–only “better” or “more effectively” (which is us implying that you really weren’t doing it “right” before)–only makes us look kinda stupid to them.

I think the GIANT piece of the puzzle missing is us. Our stories and experiences. The truth is, we have no idea what the heck is going on with people’s bodies these days. We instituted a nationwide dietary prescription based on science that was inconclusive and preliminary. The experiment so far has been unsuccessful at producing the anticipated results (to be diplomatic about it). But we don’t know specifically what effects the experiment has had on our adaptation to this radical change in environment–epigenetically, behaviorally, etc.–because we refuse to acknowledge that a radical experiment is even underway. Until our stories–yours, mine, others–are part of the qualitative data collection on this experiment, we will be stuck with this (or another) top-down 1 size diet Rx. Scientists will keep guessing at what is “wrong” with us, because none of them actually think there is something “wrong” with telling us what is “wrong” with us!

I’m right there with you. When I think, oh yeah, I got fat & sick (and quite likely set my kids up for future health problems) for no good reason . . . well, the rage got me through 4 semesters of biochemistry anyway 🙂

I have authored three books: Eat, Drink, and Be Gorgeous, Secrets of Gorgeous, and The Eat, Drink, and Be Gorgeous Project. All three challenge conventional RD “wisdom”. I am currently writing Cave Women Don’t Get Fat, which is due out next summer.

Thanks so much for the kind words & you really are gorgeous! I have a good friend who keeps saying that all of us who have stayed beautiful as we age because we don’t eat low-fat, whole-grain, low-cal diets need to get together and start promoting this angle! I have a really scary driver’s license picture from the end of my low-fat vegetarian days. 5 years later, with my sat fat face, I look 10 years younger!

I’d love to collaborate! I’m in the middle of trying to figure out how to come up with a sort of Unified Theory of Wellness–mind, body, spirit (as if they are somehow disconnected!)–that puts the whole picture together: food, movement, stillness (and by “stillness” I mean sleep, meditation, quiet time, “turn off the computer” time, etc.) We should talk . . .

Inspiring stories about some great women! And I am sure there must be many more out there that are working behind the scenes to elevate our profession. I am really glad to see Annette, Kris, and Valerie on your list, they are all so remarkable. Kris keeps working tirelessly and she does it without any financial return. Valerie – 4 young children and so accomplished. And Annette – she is so kind but so willing to stand up for what is right. My daughter Laura has told me so many good things about Amanda Holliday, that she is such a great internship director. Please allow me to say that you, Adele, are a hero to all of us, especially me! Thanks for your kind words – I am truly blessed to have you to call my friend.

Thanks for the very kind words, but it’s true: if it weren’t for you, I wouldn’t be here at all! Honestly, when I started putting this list together, I was amazed at how many names I had–and you’re right, there are probably many more. And think of all the women coming along behind us! Laura is already such a star in her own right too. It’s pretty cool & gives me lots of hope for the future.

When it comes down to the goal line stance, Dr. Slavin was the main ball carrier — the head of the carbohydrate and protein committee — and she failed to score. The USDA still promoted high carb and even lower fat eating. They still based their diet on Minnesota wheat where the doctor is from. She could have made a scene. She could have walked away. She fell in line like a good RD. She’s as guilty as the rest of the team. Words do not make up for another seven years of wrong guidelines.

Have you read the transcripts? How about the Dietary Guidelines Advisory Committee Report–which is different from the policy statement that is the US Dietary Guidelines? What do you know about the DGAC, DG and USDA Evidence-based Library processes? The system is set up so that people who come to the process attempting to follow the science and advocate for the people are ultimately shut down. I think Slavin was one of those people.

If you follow Dr. Slavin’s work through the transcripts, she’s arguing for what the science says (which is pretty much all over the place–see the sections on sugar–making it very difficult to use the science, as it was given to the committee to use, as an argument for anything but more of the same). She is also arguing for making sure that essential nutrition needs are met before everybody starts freaking out about chronic disease prevention. Slavin went out on a limb by asking for the creation of a protein subcommittee (there had not been one in the past) because she understood the importance of this macronutrient to essential nutrition needs. But in the final Guidelines, that committee’s work is essentially obliterated in one sentence: “Inadequate protein intake in the United States is rare.”

I can’t speak for her, but my impression from reading the work that she’s done since the DGAC is that she was pretty demoralized by the whole activity. She could have walked away or made a scene. I’m not sure what that would have accomplished, and we should all be sensitive to the personal and professional obligations and constraints that may be in place to ensure that experts who are welcomed into circles of credibility such as the DGAC are not going to do any such thing. But you can rest assured that the wheat growers in her state aren’t going to arrange for her to get raise at U of M as a result of her work on the DGAC. Since being released from her obligations on the DGAC, she has been an outspoken critic of the system. Brava for her.

I followed it some. She is also a major contributor, if not the sole contributor, to the assertion that oatmeal is good because it lowers cholesterol. This whole mess we’re in needs revolution, not adjustment, and while I know I can’t ask such a person to throw away their livelihood , I still want more fight out of her. A positive move such as joining Taubes-Attia’s team would be interesting.

I’ve not rooted around in the oatmeal/cholesterol science, but let’s just say that eating oatmeal does lower cholesterol (total? LDL-C?) and is not just “associated” with eating patterns of people who have lower cholesterol, which is another issue. The problem is not the science that shows that; science shows a lot of things. The problems are the policies that say it is okay to put this information on a box of sugar-filled oatmeal as a health claim (FDA); that have convinced consumers that lowering cholesterol is always a good idea (AHA); that have encouraged consumers to believe that eggs are scary and you’re better off with sugar-filled cholesterol-lowering oatmeal instead (USDA/HHS).

Yeah, I was hoping for more of a fight too. But imagine being in the room when this conversation went down:

DR. SLAVIN: But, you know, it kind of comes back to the choline recommendation we heard about [choline is a shortfall nutrient in our diets]. We are not meeting that. Nobody is really thinking about how that’s — I don’t know if that’s Shelly’s. Is that Nutrient Adequacy [who] would think about how we’re going to –

DR. NICKOLS-RICHARDSON: Right. So, specifically to choline, looking at what are the health outcomes, what are the health endpoints that we would need to look at, what does that as a shortfall nutrient mean to us, and then where do we go to the foods to meet those recommendations? I think I agree with Larry, what he said earlier though. I think we have to focus on those nutrients, the shortfall nutrients that seem to have a fairly profound health implication. I mean I think we have to triage some of those nutrients. That’s all. But eggs, I mean, are we dealing with eggs anywhere? Is that in fats?

CHAIR VAN HORN: Fatty eggs. (Laughter.) Joanne, are you finished?

DR. SLAVIN: Yes. Absolutely.

I think I’d feel pretty finished at that point too.

So, would you want to join a community that refers to you as a “dumbshit nutritionist”?

Thanks, Adele! I’m surprised and honored to be on your list, since I’m no longer an RD.
As for Dr. Slavin’s difficulties with the committee, those difficulties go way back – see Luise Light’s comments when she and her committee first developed the Food Pyramid http://www.whale.to/a/american_food_pyramid.html . I’m always amazed that this simple website still comes up. The system was rigged from the start. I think it’s really important to let our legislators know what is going on, and how it is contributing to the escalating sickness care costs in the country.

You may not be an RD now, but you got the same RD training as all the rest of the RDs out there, and yet you continued to think for yourself and educate yourself–even after retirement! I think that’s pretty remarkable.

Yes, Luise Light has been a figure of interest to me for a while. She seems to know a great deal about the intersection between science and policy. I just read that she died in 2012. I wish I’d had the opportunity to meet her.

I think so. It will be a little weird when the Academy of Nutrition and Dietetics says “Our first concern should be getting appropriate nourishment by eating minimally-processed/whole foods, not preventing chronic disease by eating highly-industrialized foods ” but I think I’ll be able to handle it.